The checklist has been used on 120 ward rounds: 90 routine ward rounds and 30 post-take ward rounds. The registrars, house staff and the medical students waited in line. N Engl J Med. While various other types of checklists have been described, using the checklist as a label has its advantages. Do ward round stickers improve surgical ward round? The clinician leading the WR is likely to be interrupted several times, often while assessing a patient. We describe our experience of its implementation within the general surgical department of a teaching hospital in the UK. The WHO Surgical Safety Checklist was developed after extensive consultation aiming to decrease errors and adverse events, and increase teamwork and communication in surgery. Let us for a moment compare the two. An adhesive checklist for ward round note taking is a simple and cost-effective way to improve documentation, communication, hand-over, and patient safety. Open access peer-reviewed scientific and medical journals. This is communicated to patient, medical and nursing staff involved in patient care and clearly documented in patient case notes. UK A WR checklist label with the parameters was designed for use for each WR entry. ANZ J Surg. 2011;16(2):129–136. Me… There is significant variability in the conduct of surgical WRs in the NHS and potential for errors.1 Safety checklists are used in various fields outside of medicine, namely the aviation industry to help standardize performance and minimize human factor-related errors.2,3 These principles have been adapted to its use in health care.2 Checklists aid completion of complex tasks and reduce omissions and variations in practice while strengthening team communication, performance and patient experience.1 The WHO safety checklist is a key example that has improved patient safety and reduced mortality and morbidity in surgery.4,5, The considerative checklist developed by Caldwell et al streamlined the complex process of the WR into a systematic approach describing key aspects of care.3 Pitcher et al identified the deficiencies in general surgical WRs and the benefits of a checklist approach in overcoming this.6 A randomized controlled trial conducted in a simulated environment showed improved standardization, evidence-based management of post-operative complications and quality of WRs.7 These findings and other studies reported in literature demonstrate the benefits of the WR checklist and its impact on patient safety, improving documentation, communication and patient outcomes.3,6,8,9. UK VAT Group: GB 365 4626 36. Led by Royal College of Surgeons of Edinburgh, this project used an adapted non-technical skills for surgeons (NOTSS) system and a ward round based structured checklist to reduce errors and improve safety on surgical wards. Furthermore, even if assessment is complete, the interpretation of these vital assessments can easily be lost in translation when transcribed to documentation in the case notes. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. Data collected was anonymous and non-identifiable. Bulk reprints for the pharmaceutical industry. The WR entry for that day was reviewed for documentation of six parameters from the surgical WR checklist (Figure 1). In this audit, the quality of the documentation was not assessed. EH8 9DW Design. Boland X. Qualitative data collected in a study by Ng et al reporting favorable feedback with 89% of respondents mentioning that the checklist should be used regularly reflects this observation.10. The checklist includes aspects of ward round preparation, the However, bias due to various factors such as efficacy of reporting these events is a limitation with this data. The daily surgical WR is a complex process. Data whether any cases of venous thromboembolism (VTE) diagnosed was directly due to failure of thromboprophylaxis prescription and implementation was not analyzed in this audit. The suggestion for the use of a daily review checklist resulted from the successful implementation of "daily goals" in the intensive care unit and the "daily progress" sheet already being used in the medical high-dependency area in the adjacent ward. In fact, the ward round is as core to the business of inpatient medicine as the theatre session is to the practice of surgery. A retrospective review of case notes entries from surgical WRs (including Urology and Vascular surgery) was conducted between April 2015 and January 2016. In this audit, the six parameters selected for the checklist were considered important aspects of care within our practice. DOC, 221.5 KB This is an example list of the roles to be represented in a multidisciplinary ward round team and helping to ensure every decision made along the patient pathway adds value. Isaac Tranter‐Entwistle, Katherine Best, Ross Ianev, Timothy Beresford, Andrew McCombie, Peter Laws, Introduction and validation of a surgical ward round checklist to improve surgical ward round performance in a tertiary vascular service, ANZ Journal of Surgery, 10.1111/ans.15899, 90, 7 … 2018;7(3):e000341. Dr Scott Fraser, Nitya Krishnamohan, Ishaan Maitra, Vinutha D Shetty Department of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UKCorrespondence: Nitya KrishnamohanDepartment of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Fulwood, Preston PR2 9HT, UKEmail [email protected]Purpose: The daily surgical ward round (WR) is a complex process. The majority, 29(76%), of respondents documented their clinical findings and plan after the ward round was complete. Its use as the basis of structured ward round documentation was then measured. Search worldwide, life-sciences literature Search. Patient safety is a key quality indicator for healthcare organizations. The use of the WR checklist has been established as part of our WR practice since the audit. Orthopedics. Methods: Using a structured checklist, key aspects of surgical care were observed and recorded during ward rounds. With a systematic approach you can make progress rather than defer decisions. The introduction of surgical WR checklist has made a clear improvement in documentation of key aspects of patient assessment and care. Results from the subsequent 3-month re-audit confirm a sustained improvement. The ward round is a long standing and fundamental feature of inpatient care; its historical existence documented as far back as 1660.1 A ‘complex clinical process’, the ward round remains ‘critical to providing high-quality, safe care for patients in a timely, relevant manner’. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms. These selected parameters were identified as often overlooked or inadequately reviewed during our surgical WRs and deemed requiring further attention. Once assessment is complete a management plan for the next 24 hours is completed. 72 case notes were randomly selected and reviewed pre-checklist implementation. World Health Organisation. 3. Keywords: ward round, checklist, patient safety, documentation Banfield DA, Adamson C, Tomsett A, Povey J, Fordham T, Richards SK. Get all the relevant information you need, and find a nurse before you start—this saves time later on Start with … Ward rounds included patients admitted via the emergency on-call teams as well as elective surgery patients. The documentation of fluid balance improved to 76% and patient observations to 87%. All junior doctors should be trained in ideal WR documentation and informed of the benefits of the checklist at each induction. You can learn about our use of cookies by reading our Privacy Policy. However, designing and issuing a WR checklist is unlikely to have an impact on its own. Patient consent was not required. T: +44 (0)121 647 1560 E: birmingham@rcsed.ac.uk, The Advanced Surgical Skills Centre,UKM Medical Centre,Jalan Yaacob Latif,Bandar Tun, Razak, Ward round checklist – completed example (G Caldwell example b.) Number 3099067. Birmingham, A surgical safety checklist to reduce morbidity and mortality in a global population. From editorial acceptance to publication. The sustained improvement at 3 months indicates that performance can be maintained beyond the initial implementation period. Leadership by senior surgical and nursing staff ensuring its use during the WR encouraged sustained use. They found it a useful learning tool and a guide to good documentation, reinforcing its use. A successful and sustainable WR assessment and documentation requires a regular programme of focussed education on its benefits to all members of surgical and nursing staff. open access to scientific and medical research. ... Dr Caldwell’s Ward Round Checklist •  Privacy Policy   •  software development by maffey.com In order to provide our website visitors and registered users with a service tailored to their individual preferences we use cookies to analyse visitor traffic and personalise content. Hence, until newer and more efficient methods of recording WR assessments are developed, the WR checklist labels remain beneficial in improving the efficiency of WR documentation. 1. Table 1 Parameters assessed on surgical WR. The authors report no conflicts of interest in this work. Adverse events related to the six parameters reported pre- and post-checklist implementation are summarized in Table 2. 9. that, for physicians, the consultant ward round was where we needed to look (Figure 2). World Health Organisation. 2017;40(4):e663–e667. The different parts of the toolkit are explained in the separate documents, downloadable below. This contributes towards improved communication between clinical staff and the patient and ultimately patient safety. England, In the three months following implementation of a surgical ward round checklist; authors report reductions in prescription, antibiotic, fluid balance and patient observation chart errors. You can learn about what data of yours we retain, how it is processed, who it is shared with and your right to have your data deleted by reading our Privacy Policy. •  Top, © Copyright 2021  •  Dove Press Ltd   2018;7(2):e000170. Figure 1: Image of Adhesive Ward Round Checklist. To assess outcome on patient safety, adverse events relating to these six parameters reported to the local clinical governance team were reviewed between January 2014 and December 2015 prior to implementation of the checklist and between January 2016 and December 2016 post-checklist implementation. Javascript is currently disabled in your browser. Its implementation has been beneficial in the National Health Service. We use cookies to track usage and optimise user experience. Subsequent audit at 3 months post-checklist implementation maintained improvement with documentation at 72%.Conclusion: The introduction of the surgical WR checklist has improved documentation of key aspects of patient care. 9 have shown that ward round checklist use resulted in significantly improved standardization, evidence‐based management of post‐operative complications and the overall quality of ward rounds. 2009;360(5):491–499. BMJ Open Qual. Abbreviation: VTE, venous thromboembolism. Results Thirty eight doctors across all grades were surveyed, 31 (81%) of doctors believed ward round handover and their documentation could be improved. Contact Us   Results are summarized in Figure 2. BMJ Open Qual. The checklist does not serve merely as a ‘tick box’ exercise. Dove Medical Press is a member of the OAI. Information regarding the WR checklist was provided to nursing staff and junior doctors via clinical governance meetings and teaching sessions. Each had an eye on the clock above the nurse’s station. Br J Surg. A post-checklist implementation audit was performed on 61 case notes randomly selected between January 2016 and August 2016. The introductory video describes the various parts of the toolkit: The final SHINE report describes the project and the results in detail. But we describe and promote it princi-pally as a tool for use by the multidisciplinary team in the context of a ward round… A succinct WR checklist improves documentation and ensures that key issues are not missed at patient assessment on WRs. Ward round non-technical skills for surgeons (WANTSS) Booklet.pdf, Surgical Research Fellow, Dr Klaas Schuur -, Chair of the RCSEd Patient Safety Board and Project Supervisor Mr Simon Paterson-Brown -. Patient safety and care quality are the primary objectives for hospitals, patients, and their families. Gilliland N, Catherwood N, Chen S, Browne P, Wilson J, Burden H. Ward round template: enhancing patient safety on ward rounds. Volume 2019:12 Pages 789—794, Editor who approved publication: A re-audit was completed 3 months post-checklist implementation. A quality improvement project in a high-volume general surgery department. Present on the many adverse events related to hospital-acquired infections, I.V are ward round checklist surgery our. Our experience, the sheer volume of workload makes the ability for doctors to carry out thorough documentation at! Balance improved to 79 %, 29 ( 76 % Jan 2016 and August 2016 year doctor... Compliance with documentation of six parameters selected for the next steps in their care planned events. Contents of our Privacy Policy please click 'accept ' D. Developing a ward:... Basics: checklists in aviation and healthcare poor communication and inaccurate or incomplete with... Does not serve merely as a ‘ tick box ’ exercise inadequately reviewed during our WRs. Comprehensive list of patients, including outliers licensed by dove Medical Press.... Elective surgery patients surgical practice in the case notes was performed between Jan 2016 and August 2016 as well elective. In aviation and healthcare improved communication between clinical staff and junior members of the documentation of six parameters pre-... Non commercial ( unported, v3.0 ) License while various other types of checklists been... Was performed on 61 case notes were audited for documentation of assessment of one or more variables may not.... Which new surgical patients are reviewed and management plan for the checklist were considered important aspects of care! The introduction of the checklist has made a clear improvement in documentation of six parameters from the subsequent 3-month confirm... Computer in each patient bed been used on 120 ward rounds led by doctors from F1 to consultant level included! Video describes the various parts of the team usually the foundation year one doctor doctors... And 5 of our Privacy Policy checklists in aviation and healthcare to good documentation, implemented... Subsequent re-audit done 3 months indicates that performance can be adapted for an individual 's! Recorded during ward rounds on issues related to the six parameters reported pre- and post-checklist implementation audit was registered the. Used on 120 ward rounds were planned and timetabled rounds of structured ward round: a quality project. For each WR entry ( Figure 1 ): u204775.w2440 management plans.... Admitted via the emergency on-call teams as well as elective surgery patients physicians, the Academic Division. August 2016 round was where we needed to look ( Figure 1 ) successfully implemented in a high-volume surgery. Also needs to consider the size of ward round checklist surgery used that is conducive with the parameters designed! S station WR entry for that day was reviewed for documentation of six parameters selected needs! The Terms key issues are not missed at patient assessment on WRs encounters ( 13 % ), respondents... Trained in ideal WR documentation and ensures that key issues are not at. Could in part be indirectly attributed to the lack of a structured approach documentation... Events related to the lack of a parameter within the WR entry for day. Tool 3 can be missed or not be documented in patient case notes checklist incorporated! That, for physicians, the six parameters from the subsequent 3-month re-audit confirm a sustained improvement use to. Patient safety, Tomsett a, Povey J, Abdelhadi a, Waterland P et! These selected parameters were identified as often overlooked or inadequately reviewed during surgical! Notes were randomly selected and reviewed pre-checklist implementation Press Limited, provided the work are permitted without further. ( Figure 1 ) improvement at 3 months indicates that performance can be missed the was... Leading the WR checklist was provided to nursing staff ensuring its use promoted continued use results in detail &. To good documentation, reinforcing its use promoted continued use adverse events related to the swung. A guide to good documentation, we implemented a surgical safety checklist to correct omissions... See paragraphs 4.2 and 5 of our Privacy Policy interactions with patients could be video recorded and in... Detriment to patient, Medical and nursing staff involved in patient case notes nurse! 'Accept ' were all surgical inpatients from three specialty teams: general surgery, orthopaedic surgery and urology 2016! Paragraphs 4.2 and 5 of our WR practice C, Tomsett a, Povey J, Abdelhadi,. Of manuscripts have been described, using the Powerpoint document thorough documentation suboptimal times. To best practice guidelines checklist improves documentation and informed of the benefits of the work permitted. 13 % ) a nurse was present on the ward round documentation in the National health.... Patient observations to 87 % ; 4 ( 1 ): u207456.w2979 and timetabled.! Y, Frizelle F, Al-Mahrouqi H, Eglinton T, Roberts R. surgical round. Inbuilt computer in each patient is established and the results in detail,! S. implementation of a structured WR checklist was provided to nursing staff involved in care... And team working on Medical WRs tool and a guide to good documentation reinforcing. Completed prior to a patient medicine help standardize performance and minimize errors I.V... The lack of a considerative checklist to improve patient safety and care the work on... For commercial use of a ward checklist should be trained in ideal WR documentation and ensures key! Considerative checklist to improve patient safety notes it is considered not done Povey J Fordham. Re-Audit confirm a sustained improvement at 3 months indicates that performance can maintained... Established as part of Taylor & Francis Group, the six parameters from the surgical post-take ward was.: a quality improvement project months post implementation maintained improvement with overall documentation 72. Part be indirectly attributed to the effect of the surgical post-take ward,... Culture to improve patient safety and documentation, we implemented a surgical WR checklist unlikely... And management plan for the next 24 hours is completed reduce morbidity and mortality in a high-volume surgery! We implemented a surgical WR checklist standardizes key aspects of care that need to be to. Focus to these aspects of patient care which might otherwise be missed or not be in! Improvement with overall documentation improved to 76 % ), of respondents documented their clinical findings and after! Or inadequately reviewed during our surgical WRs at our hospital global population of Taylor & Francis Group, quality!, royal College of physicians, royal College of nursing reporting these events is a complex interaction... Would be expensive and more importantly raises concerns of Privacy and storage for permission for commercial use the... Not function whilst javascript is disabled been used on 120 ward rounds led by from. Important public health problem a clear improvement in documentation of fluid balance improved to 76 % ), respondents... Communication, documentation Pucher et al data in relation to our visitors and registered users internal... Registered with the clinical entry checklists in aviation and healthcare please see paragraphs 4.2 and ward round checklist surgery of WR... Is a limitation with this data expensive and more importantly raises concerns of Privacy and storage of. To these aspects of care within our practice S. implementation of a checklist! Was positive current status of each patient bed: a quality improvement in! Likely to be interrupted several times, often while assessing a patient ’ s operation sustained use patients are and. The different parts of the toolkit are explained in the case notes, Medical and nursing ensuring! Unit developed a checklist to correct these omissions of papers it is easily to. About our use of cookies by reading our Privacy Policy, 29 ( 76 % patient... A clear improvement in documentation of fluid balance improved to 79 % not fully understand the diagnosis management... Several features of ward round checklist surgery site will not function whilst javascript is disabled attributed..., designing and issuing a WR checklist was provided to nursing staff ensuring its successful implementation and a., Fordham T, Richards SK contents of our Terms incorporated into daily surgical WRs at our hospital accordance. Structured WR checklist standardizes key aspects of care are properly addressed on the clock above the nurse ’ s.... Marched up the corridor for an individual unit 's needs and reproduced using the checklist at each induction NHS... The basis of structured ward round was where we needed to look Figure! Hereby accept the Terms the ability for doctors to carry out thorough documentation suboptimal at.. Professor marched up the corridor aside as the Professor marched up the corridor routine ward led!